How to identify hypoxia in yourself. What is fetal hypoxia: symptoms and signs. Among these diseases are

What is fetal hypoxia

While the baby is in the uterus, his lungs are not yet working. They are filled with liquid, and although they sometimes respiratory movements oxygen does not flow through them.

The only source of oxygen for the baby is the placenta, and she, in turn, receives it from the mother's blood. If at any of the stages its supply is disturbed, it develops oxygen starvation fetus, or hypoxia.

If this is not possible, the issue of urgent delivery should be raised. In chronic fetal hypoxia, treatment should also be eliminated while eliminating the causes and reducing the suffering of children. An important place in the treatment of hypoxia is prevention, which should begin when planning a pregnancy or when visiting a prenatal clinic to register a pregnancy.

However, this serious problem. The American Academy of Pediatrics is quite strict and requires that these four criteria be met when talking about perinatal asphyxia, but this creates some practical problems. Not all centers have the availability or practice of taking umbilical artery gases, for example, so many times that the first element of the definition cannot be determined.

Fetal hypoxia during pregnancy

The time of onset of hypoxia, as well as its duration, play a very important role in the baby's future. The sooner and longer, the worse. On early dates hypoxia can cause abnormalities in the development of organs, including the brain of an infant, and lead to neurological problems in future.

On later dates pregnancy hypoxia is also unsafe. It does not allow the baby to develop correctly and in time, causes intrauterine growth retardation. Severe hypoxia in the later stages may lead to the need for an early caesarean section.

Notwithstanding this, the previous definition allows a comparison to be established between different centres, if all agree to use it. For an obstetrician of the perinatological group, one of the most common causes demand is the diagnosis of asphyxia; This is one of the reasons the American Academy of Pediatrics should use this definition in the legal field.

Causes of hypoxia

Ernn Gonzeles of the Catholic University formulated a definition of suffocation in which he used other criteria; According to this definition, we can speak of asphyxia when two of the following elements are present. If this definition is used, the incidence of asphyxia will increase; That's why it's important to agree. The problem with this definition is that, from a practical point of view, it comes from medical center, which has some diffusion in our environment, but only in ours; in other countries it is not known or will not be used.

Hypoxia in childbirth

In addition to the time of pregnancy, dangerous hypoxia can begin during childbirth, then it is called acute. Normally, all children at birth experience a moderate lack of oxygen and are quite well adapted to temporary hypoxia.

However, in some cases, birth hypoxia can be dangerous: in premature babies, with prolonged labor, bleeding or infection.

Only 1% need resuscitation. Mortality is therefore attributed to the failure of the intervention for this small proportion of newborns in need of resuscitation, which will eventually correspond to 20% of perinatal deaths worldwide.

The fetus is always hypoxic, but these values do not determine damage, only the pH is slightly lower than normal for an infant or adult. Ischemia has its origin in peripartum, that is, before or during childbirth, although it can also occur after the birth of a child. In general, damage occurs before birth; in 70% of cases this occurs during childbirth and the outgoing period.

Severe hypoxia with an almost complete cessation of oxygen supply is called fetal asphyxia. Asphyxia is practically suffocation. It can develop only as a result of complications: premature detachment of the placenta, multiple entanglement of the umbilical cord, strangulation of the umbilical cord, and some others.

Possible causes of hypoxia

From the mother's side:

Treatment of intrauterine fetal hypoxia

Ischemia can occur even before delivery, and in these cases, it is usually impossible to determine exact reason. On the other hand, 10% of episodes of hypoxia and ischemia that lead to asphyxia occur during the neonatal period. Premature hypoxia and ischemia are more likely to occur after birth because they are much weaker in the face of respiratory problems, hypotension, etc. therefore, the neonatal period is becoming increasingly important in the preterm period.

Causes of Perinatal Asphyxia Most asphyxia occurs in the prenatal period. The cause of asphyxia can also be rooted in the fetus. Thus, asphyxia, which arose in prenatal period, may have different reasons and steps must be taken to avoid it.

Low - less than 120g / l - blood hemoglobin (anemia);
Bronchitis, asthma and other lung diseases;
smoking during pregnancy;
kidney disease;
Diabetes and others.

From the side of the fetus:

Congenital malformations;
Intrauterine infections;
Fetoplacental insufficiency;

During childbirth:

The newborn may suffer from hypoxia or ischemia due to cardiac, respiratory or infectious problems that affect these two systems. This child may be born well, without any brain or cardiac manifestation, but the organs affected by this defense mechanism, may create difficulties later. For example, if the bowel has been ischemic for a long time when you start feeding, you may have necrotizing enterocolitis. Similarly, problems with pulmonary, liver or kidney failure can occur.

Incorrect presentation of the fetus (pelvic, oblique);
Multiple births (twins, triplets);
Prolapse of the umbilical cord;
and others.

Signs of fetal hypoxia, how to determine fetal hypoxia?

In the early stages, it is almost impossible to reliably detect hypoxia, it can only be assumed if the mother has anemia or another disease.

The ideal would be to recognize hypoxia when the redistribution of the habit begins, to intervene at that moment, but in practice this is impossible; After many decades of research, we still do not have the elements to determine the exact moment when this mechanism begins to overload.

The heart rate increased and then fell; flow to the lungs, which are not noble organs, fell very quickly from the onset of primary apnea, and renal flow fell a little later. There is no biochemical or radiological element that allows you to accurately know the time. Some clinical elements may determine what happens. If a baby is born with primary apnea, it is almost always enough to dry him out and give him oxygen to start breathing; in this case, he most likely suffered a very short period of suffocation.

After 18–20 weeks, when the baby begins to move with might and main in the uterus, the mother may suspect hypoxia by reducing its activity. If the movements of the fetus have become sluggish and more rare, it is necessary to see a doctor for an examination.

Signs of hypoxia during examination:

On - a delay in the development of the fetus, that is, its size and weight are less than normal for a given period;
On: deterioration of blood flow in the placenta, in uterine arteries a decrease in the fetal heart rate (bradycardia);
On CTG (after 30 weeks): a total score of 8 or less, a fetal condition index (PSP) of more than 1, a decrease in basal heart rate less than 110 at rest and less than 130 during movements, etc. CTG tends to give many false positive results, that is, to identify hypoxia where there is none. In the case of a bad analysis, most often you just need to redo it the next day.

IN difficult cases other diagnostic methods are also used, such as amnioscopy and blood sampling from the skin of the fetal head (only in childbirth).

All this is described in animal studies, since it is impossible to conduct comparative study in humans to check if these variables are supported. Neurological compromise The child may develop hypoxic-ischemic encephalopathy, which may present with seizures, among other signs.

It can also produce leukomalacia, a lesion specific to prematurity that consists of cysts located in the white matter secondary to necrosis of that part of the brain. This injury occurs around the ventricle and can lead to intraventricular hemorrhages, which are also common in preterm infants.

During childbirth, the presence of hypoxia can be judged by the color amniotic fluid. If the waters are cloudy, greenish color, and even worse - with an admixture of meconium, which means that the baby is already experiencing a lack of oxygen. Transparent amniotic fluid is a sign of good blood supply and the condition of the baby.

How to deal with hypoxia

Throughout pregnancy, it is very important for all expectant mothers to walk as much as possible on fresh air. This simple rule will help you prevent many pregnancy complications, including fetal hypoxia.

Causes of fetal oxygen starvation

Finally, as a delayed manifestation, cerebral palsy can develop, although this is controversial, since almost all studies aimed at identifying the cause of this paralysis describe that, paradoxically, in most cases there is no recognized asphyxia in perinatal period. That is, many children with long-term neurological damage do not have clinical elements of hypoxia or ischemia in the perinatal period.

Cardiovascular system When the mechanism of redistribution is overcome and there is not enough flow in the heart, myocardial hypoxia occurs, the consequences of which are insufficient for cardiac output, hypotension and pulmonary hypertension. Pulmonary system. In the lungs, surfactant production is altered under conditions of low deficiency and acidosis, resulting in insufficient surfactant. However, this term is also controversial.

A sufficient supply of oxygen from the inhaled air ensures a good metabolism in the placenta and reduces the likelihood of hypoxia. But in addition to the prevention of walking, you can and should use it for mild treatment degree of hypoxia. No oxygen cocktails can replace 3-4 hours spent outdoors.

If there is no threat of miscarriage or increased tone uterus, it is useful to do aqua gymnastics and swimming.

Gastrointestinal System Increases intestinal motility in conditions of asphyxia due to an increase in a hormone called motilin, which increases peristalsis; this results in the release of the meconium, with the danger inherent in its aspiration. Thus, a complication of asphyxia is meconium aspiration syndrome, which can be very difficult to manage.

Other obligations Asphyxia can lead to kidney failure and tissue changes that activate the coagulation cascade and can cause disseminated intravascular coagulation. Bone marrow may also be affected and suffer from thrombocytopenia, leukocytosis marked by a massive release of neutrophils, and a shift to the left, which can confuse the picture with an infectious process.

In more serious cases, at the decision of the doctor, hospitalization in the maternity hospital and treatment with medicines are necessary. For this apply.

The term "hypoxia" is understood as a pathology in which oxygen does not enter the body in enough or poorly absorbed by tissues. At intrauterine development this condition can lead to serious complications. This article explains why fetal hypoxia occurs during pregnancy, and how it manifests itself.

The liver has a large supply, so most of the time, hepatic remodeling is only evident at the biochemical level, but it is useful as a marker of hypoxia. Necrotizing enterocolitis consists of intestinal necrosis associated with ischemia, infection, and early feeding, or all of these elements. In children who have had a less important perinatal asphyxia, those who begin formula feeding rather than breast milk, with very large volumes, this disease can be caused as a manifestation ischemic lesions intestines.

Etiology

Among the main causal factors can be called:

Certain physical illnesses in the mother. Most often, cardiovascular disorders, anemia, kidney damage and diabetes, as well as pathologies are of etiological significance. respiratory system(For example, Chronical bronchitis, pneumonia, bronchial asthma).
Circulatory disorders that cause pathologies of the placenta, premature birth or other anomalies (for example, overbearing the baby), as well as complications of childbirth.
Diseases of the fetus. Hypoxia cause birth defects, hemolysis, infection of the fetus, prolonged labor, in which the baby's head is compressed for a long time.

The causes of this pathology also include impaired blood flow through the compressed umbilical cord or when it falls out, toxicosis, the presence of several fetuses in the uterus, overmaturity of the child and frequent stress. The lack of oxygen negatively affects, first of all, the nervous system. Hypoxia inhibits the development of the brain, causes changes in the structure and functions of blood vessels, and also slows down the development of the blood-brain barrier. Negatively, hypoxia also affects the tissue of the kidneys, intestines and fetal myocardium. Fetal hypoxia during childbirth is observed under the following conditions:

Metabolic levels exhibit hypoglycemia, hypocalcemia, and metabolic acidosis, which are typical manifestations asphyxia and that a diagnosis should be actively sought as defined by the American Academy of Pediatrics. Neurological compromise in asphyxia Neurological disorders depend on age. Preterm infants have a fundamental white matter lesion that manifests as periventricular leukomalacia, which causes pores around the ventricle. These children are subject to high risk development cerebral palsy.

difficult and prolonged childbirth;
the presence of birth trauma;
a narrow pelvis in a woman and a large fetus;
the use of sedatives and analgesics during delivery;
use of special tools (for example, obstetric forceps);
compression of the baby's neck by the umbilical cord.

In children with the terms ischemia and necrosis occur in the border areas between the anterior cerebral artery and the middle cerebral artery, as well as between the latter and the posterior cerebral artery. Cerebral edema and areas of necrosis are not easy to detect at the beginning, so scanning or resonance, in the early days, in best case can serve to recognize edema. Necrosis does not appear until the third or fourth week, when pores appear in the white matter. Subsequently, this will manifest as brain atrophy and microcephaly; This is why pediatric supervision is so important.

Clinic

Depending on the rate of development and duration, hypoxia proceeds acutely or in a chronic form. Acute hypoxia usually develops with pathological childbirth when they are rapid or, conversely, protracted, with anomalies of the birth act, as well as during pregnancy itself (for example, when the uterus ruptures, or premature detachment placenta). With asphyxia, work deteriorates sharply important organs. The fetal heartbeat accelerates or slows down, arrhythmias appear, asphyxia develops, which is dangerous for the life of the child.

Microcephaly is an excellent marker of poor neurological development, almost the best. When this sign is detected in the first six months of life, one can be sure that this child is a carrier of serious neurological damage. pathological anatomy of these cases shows that there is selective neuronal necrosis, ventricular leukomalacia, which is characteristic of preterm infants, multiple foci of ischemia, and, finally, damage to the brain stem.

This subject is hypoxic-ischemic encephalopathy, which is classified into three classes. In the 1st grade, the child is sick, but very crying or irritable, has wide eyes, normal muscle tone and very sharp osteoencephalic reflexes, albeit without an increase in area. Moro is hyper-reactive and full, jumps easily, has constant thrusts, suction is weak, and spasms are almost never present. In general, these manifestations last about 24 hours.

Moderate but prolonged lack of oxygen leads to intrauterine malnutrition. This is a condition in which the size and weight of the fetus is significantly less than normal. A uniform developmental delay (symmetrical hypotrophy) is observed. Often chronic hypoxia provokes the development of asymmetric malnutrition. It stunts growth internal organs and weight gain, but growth in length is preserved. Children as a result of this disorder have wrinkled skin (as in old age) and excessively thin limbs. Symptoms of hypoxia during fetal development are as follows:

These changes can last from 2 to 14 days. Many of these children have such a nipple that they need to be fed. They recover within 7-15 days but should be evaluated periodically by a neurologist as they are at risk for long-term complications. If the pediatrician is experienced enough, he can make checks and refer him to a neurologist only after 6 months and a year to evaluate his development.

Fetal hypoxia: symptoms

Mortality in this degree was 90%; nowadays, with all the advances in management, it's down to 50%, but all remain sequels. This is the first time that a tiered adherence to asphyxia has been requested in the laboratory. Some elements that can serve are a specific fraction of creatine phosphokinase, which is the one found in the brain; If it is elevated, theoretically there is brain damage.

transient heartbeat and high blood pressure, which subsequently decreases, turning into bradycardia and hypotension;
rheological changes are observed, which include thickening of the blood, which in turn provokes swelling of the tissues;
the tone decreases blood vessels and blood circulation slows down, which causes organ ischemia;
the balance of electrolytes changes, which manifests itself in the form of acidosis.

Consequences such violations is asphyxia. birth trauma and even the death of a child.

Diagnostics

Before the 18th week of pregnancy, it is impossible to independently determine hypoxia. To confirm oxygen starvation, special instrumental examinations. In the third trimester, a woman already feels the movements of the fetus well, so it is much easier to suspect the development of hypoxia. There is a so-called "Method 10". Its essence is to count the movements of the fetus during the day. Ideally, if a woman registers at least 10 episodes of baby activity (meaning not individual movements, but their cycles). Hypoxia is manifested by rare movements. In addition, in late pregnancy, turbidity of the amniotic fluid is detected. For confirmation this complication perform CTG.

To identify chronic form hypoxia is carried out functional test. Record the heart rate of the fetus. Then the woman walks up the stairs, after which the heart rate measurement is repeated. Intrauterine hypoxia the fetus is manifested by the occurrence of arrhythmias or a monotonous contraction of the myocardium. At normal development the child's heart rate reaches 160 beats / min.

Can carry out a cold test. Heart rate decreases by 10 beats, and with a lack of oxygen remains unchanged. In addition, if a woman holds her breath, then the heart rate of the fetus changes by 7 beats. In the presence of hypoxia, there is no such regularity. WITH diagnostic purpose dopplerography, fetometry, placentography, amniocentesis or cordocentesis, as well as computer monitoring of the heart are also used. After birth, attention is drawn to signs of hypoxia:

Hypoxia in a child after birth is accompanied bad dream, startling when changing position or during sleep. The kid is restless, often turns his head, you can see how his chin is shaking. Fetal hypoxia is whole complex negative changes in oxygen deficiency, which is not a disease, but leads to the development of many pathological processes.

Consequences for the child with this condition include developmental abnormalities, lesions nervous system and low adaptive capacity after birth. The baby is diagnosed with multiple organ dysfunctions. With damage to the nervous system against the background of oxygen deficiency, convulsions, encephalopathy and cerebral edema are observed, pulmonary hypertension, heart defects, kidney failure and enterocolitis. Given such severe complications, it is important to know what fetal hypoxia is and how to recognize it in time.

Treatment

At chronic hypoxia it is important to treat those diseases or conditions that provoke oxygen starvation. Therapeutic measures also directed to the normalization of blood circulation in the placenta. Bed rest is recommended. To reduce contractility uterus, prescribe appropriate pharmacological preparations(for example, No-shpu or candles with papaverine).

To the scheme complex therapy include drugs that reduce blood viscosity and reduce the chance of blood clots forming. It helps to restore blood circulation in small vessels and improve oxygen delivery. To improve blood circulation in the placenta, Curantyl is prescribed, and with increased excitability of the uterus, it is recommended to take tocolytics.

In addition, in order to improve metabolic processes vitamins C and E, glucose solution and glutamic acid. With inefficiency complex treatment and with normal fetal viability, C-section. At acute form hypoxia should be adhered to bed rest(you should lie on your left side to prevent inferior vena cava syndrome). Prolonged inhalations of pure humidified oxygen are shown. Intravenous infusion of solutions of glucose, insulin, ascorbic acid and cocarboxylase.

For intravenous infusion can use a solution of calcium gluconate or sodium bicarbonate. With a sharp bradycardia in the fetus, atropine sulfate is administered to a woman. If there is no effect, labor should be induced or an urgent caesarean section should be performed, otherwise the fetus may die. After birth, the condition of the child is assessed using a special Apgar scale. If signs of hypoxia are detected, first of all, restore normal breathing(clear Airways from mucus), warm the child, if necessary, introduce drugs that stimulate blood circulation, use oxygen masks. If the baby is serious condition, it is placed in a pressure chamber.

After the disappearance of manifestations of hypoxia, the child and mother are discharged home, however, recovery period the baby needs constant supervision not only of a pediatrician, but also of a neuropathologist. In the future, such children should be protected from stress as much as possible, take courses therapeutic massage and take soothing baths.

Prevention

It is important for a woman to give up bad habits(even passive smoking damages the woman and the fetus). Pregnant women are advised to spend more time outdoors and eat right. Remember to rest and get enough sleep. Also, a woman should regularly visit a doctor and take necessary tests. Helps prevent fetal hypoxia proper planning pregnancy. Before conceiving a child, extragenital pathologies and diseases should be treated reproductive system, take a course of vitamin therapy.